Pain, injury, etc -- Evidence-based approach?

Playing Technique
#1

Hey folks,

I’ve dealt with pain in numerous areas over the years (chronic and otherwise), and am wondering if anyone has found any evidence-based finger/grip strengthening exercises that help with finger pain/ulnar nerve irritation/etc. Anecdotes are fine here too. I’ve had what feels like “trigger finger”, RSI, tendonitis and ulnar nerve irritation over the use. Not playing that much, probably 30 min a day, but I use my hands for work. I generally find pinky stretches and sustained index finger use (think chords held low on the fretboard) to be the most problematic.

As an aside, I’d like to generally divulge my perspective on pain and injury, based on what I’ve learned over the years, to avoid confusion, and also because I haven’t found a lot through searches covering this more extensively. Perhaps this will be informative, perhaps redundant.

Many of these may seem unintuitive or contrary to popular advice from clinicians/MDs, but this is where pain science has led:

If you want a much better-written version, simply go here (no affiliation with the site, for the record):

  1. Pain =/= “Injury”. Injury is difficult to define, and pain can be nebulous. Take this explanation with a grain of salt as I’m not a pain scientist, but the reason this distinction is important is because while we do have nociceptors that send danger signals to the brain when “damage” or “threat” occurs to a specific region, the ongoing loop from the brain is what causes “pain”. The most obvious example here is a minor cut on your skin, which generally has a fairly linear relationship with pain. When the cut heals, the pain stops.
    This isn’t always the case with tendonopathy, or most especially something like non-specific back pain. Often the “pain” loop is a danger-based one. Sometimes a “tweak” is simply exceeding load, and your brain is telling you to back off. Sometimes a “tweak” is completely unrelated, and it’s important to get things to “calm down” as fast as possible. This generally involves slightly backing off intensity of a particular activity, while most importantly continually moving. The reality is that no common overuse “injury” takes ten years, or even one year, to heal. There are much faster ways to get pain free.
    Sometimes the issue is in-between, and this is generally the case when other symptoms like swelling is involved.
    The most telling evidence of this is the lack of correlation between adverse finding in imaging studies and pain. It’s nearly 50/50 or similar for disc herniations, joint “degeneration”, ligament pathology, etc. There’s honestly relatively little point to doing imaging for most commonly experienced weightroom or similar pain. Phantom limb pain is also a fantastic example.

  2. Predictors of pain are broad, and may include a) exceeding load tolerance (combination of intensity/volume), b) sleep disruptions/stress (very consistently found to correlate with pain in scientific literature), c) expectation/fear/etc. “Bad form” is interestingly not a good predictor of injury in weightlifting. This is a bit more difficult to pin down with music, because tension, end-range stretches or similar can be equated to “load management” and can greatly increase or decrease overall strain, so I do think posture and playing relaxed are very important aspects of musical practice.

  3. Our bodies are extremely adaptable. This includes tendons, ligaments, bones, etc. For everyone that sincerely believes deadlifts are inherently “bad for you”, I can show multiple examples of people doing ridiculous, lumbar-deep-flexing, silly “creative” lifts, who do so consistently without pain or injury. Again comes down to load management over time and progressive adaptation. I believe this is the case with music as well, though generally surveying seems to indicate there are common limits. At age 30-something I’m not really interested in trying to play 7h a day, and most symphony string players I know will pop Advil or similar during long concertos or symphonies, so there does seem to be difficult ranges or degrees. Lots of individual variation as well, but the principle applies.

TL;DR: Any exercises recommended for finger pain while playing? Generally pinky pain/ulnar nerve irritation with stretchier-chords, and index finger irritation irritation when chording. Not a lot of tolerance at this point, only playing 30-45 mins a few times a week, so obvious deconditioned. Would like to be able to play 1h or so a day along with some piano an hour a day as well.

#2

Hi @Longbowman,

This is a topic which is of particular interest to me, and I’ve spent a lot of time reading on this subject.

I’ve written about my experience with repetitive strain injuries here in the past. Briefly, about a decade ago while I was typing up my thesis, I developed chronic tendinitis/tendonosis in both wrists. My symptoms were severe, I could barely hold a cup of coffee in my left hand for more than a year. I was in almost constant pain, the level ranging from annoyance to agony. The symptoms persisted for nearly two years. My guitar playing was not the cause of my injuries or pain, but my playing was heavily affected.

More about my situation here:

I don’t dispute any of the information I’ve read on the Barbell Medicine website, but I think it’s difficult to apply the concepts directly to guitar.

Absolutely. However, “intensity” is extremely difficult to quantify on an instrument.

For a guitar specifically, sub-optimal technique can easily result in a huge increase in stress. We can create leverages which mechanicaly disadvantage our muscles. We can align small, weak muscles in attempt to perform tasks which are easily accomplished by larger, stronger muscles. We can generate contrary forces through muscular cocontractions.

The forces required to play a guitar are determined by the string properties and the action height. On a 25.5" scale guitar, the fretting forces at the 12th fret is in the range of 0.32 to 0.97 Newtons per millimeter action height, giving a range of about 0.3 to 3 Newtons of fretting force across different guitars (electric 24.75" scale with 8s and low action versus acoustic 25.5" scale with 14s and high action).

Even at the upper end, that’s really not much force in comparison to human grip forces. However, there is an order of magnitude in the difference between the extremes. There is also a similarly massive difference in the forces our hands can generate through pinch versus power gripping.

Bending forces are much higher, and more significantly affected by scale length. About 5 to 10N for light strings and up to double that for heavy strings. That’s nothing compared to an average adult’s capacity for force production with the stronger muscles of the arm, even considering that bending any string requires you to bend adjacent strings aswell. However, it’s a lot for the finger extensors or the intrinsic muscles of the hand.

Again, this is minimum exertion required. Most people are working much, much harder than this.

I totally agree, and this needs to be emphasised.

Again, I don’t dispute this.

However, it’s important to stress that there are limits. Your pinch grip will never produce forces that your power grip can generate easily. Your thumb flexion with opposition will never produce forces that your thumb can absorb when utilized as a structure. Your adductor squeeze will "never* produce the force of your leg press.

Saying that bad form is a poor predictor of pain or injury and that we can adapt to tolerate sub-optimal form could give the impression that there’s little or no benefit to optimizing technique.

Technique is about efficiency. Efficiency is about effort versus effect. Technique matters.

Even if your technique is well optimized and your guitar is setup to minimize playing forces, stress is cumulative. If you’re using your hands for work, it’s very possible that playing the guitar is the straw that breaks the camel’s back. Maybe instead you would be better served thinking about how you can minimise the stress to your hands during work.

For most adult men, if they’re experiencing strain from playing guitar I think it’s reasonable to conclude that there are likely to be deficiencies in technique.

You can try to reduce intensity by playing a guitar with light strings and low action. That might help. If it doesn’t, I think it’s fair to conclude that either your playing technique is problematic, or that the guitar isn’t actually the root of the problem.

#3

BBM is a great resource. I paid for PT through them and have applied their principles to rehab my tendinopathies (I’ve had a lot – fingers, wrists, elbows, hips, and knees). I was in debilitating pain at one point; now I’m almost fully healed (still have to limit some activities, but I think this will get better with time).

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#4

Glad to hear that! Anything in particular you’ve done in regard to fingers and hands? Considering a consult with them but first trying to see if I can find someone in Canada with the same philosophy so I can bill extended medical insurance.

#5

Thanks for sharing! Glad to know your process has overall been a positive one. Regarding your own story, I’ve done much of the same, and most of my hobbies outside guitar involve “moving around”, also largely due to issues with prolonged sitting (university etc). I’ll touch on this later, but I’m in agreement with the idea that “motion is lotion”, and while “bad posture” can involve endrange or over-stressed positions, the general consensus in the physio world is that movement is best, regardless of posture, but given the issues some postures give me some of the time (i.e. craned neck on a bad couch), I generally avoid them or move around frequently. I used to be much more biomechanically oriented when I was strength coaching, but recent developments have shifted my views quite drastically.

Absolutely. However, “intensity” is extremely difficult to quantify on an instrument.
For a guitar specifically, sub-optimal technique can easily result in a huge increase in stress. We can create leverages which mechanicaly disadvantage our muscles. We can align small, weak muscles in attempt to perform tasks which are easily accomplished by larger, stronger muscles. We can generate contrary forces through muscular cocontractions.//Saying that bad form is a poor predictor of pain or injury and that we can adapt to tolerate sub-optimal form could give the impression that there’s little or no benefit to optimizing technique.

This is true, but the problem with this is we have no evidence showing we can reliably control or modify each of these tiny individual variables, and in my experience, tiny modifications and tweaks attending to this specifically are largely a waste of time. I’m sure we’re largely on the same page, but simply shooting for “efficient” technique and minimizing unnecessary movement and strain gets you most of the way there (at least for beginners), where minor tweaks tend to be for more advanced players. I also do things like when I warm up with scales or 4-note patterns I slowly pick and try to focus on the absolute minimum amount of pressure necessary.

However, a part of the reason I think de-emphasizing technique conceptually across all fields for injury reduction specifically, and instead focusing on what’s most efficient is because you essentially have the same outcomes, but without the idea that there is a “perfect” technique, or that not doing X activity with perfect technique will be disastrous, injurious, etc – ironically disseminating this idea can lead to fear and increased pain perception. In the weightlifting world, we have crazy deadlift variations people have developed and are excellent at. In the guitar playing world, we can look at someone like SRV who played bendy blues with 13’s on a 25.5", or someone like Rick Graham who probably has some of the cleanest, most efficient technique I’ve ever seen but has dealt with finger and hand issues nonetheless. Individuals and their variables are on a huge spectrum. Adaptation + lifestyle factors are massive, and people often underestimate the latter, but less so nowadays.
Not to be contrarian here for the record, because like we both agree, it’s much more difficult to quantify intensity on an instrument than in a gross-motor exercise. In my case, I’m all for increased efficiency for a variety of reasons, one of which is more longevity on the instrument. But what I’m more interested in is increasing my ceiling and tolerance for stress, which strength and endurance exercises definitely can help with. Reasoning below:

Even if your technique is well optimized and your guitar is setup to minimize playing forces, stress is cumulative. If you’re using your hands for work, it’s very possible that playing the guitar is the straw that breaks the camel’s back. Maybe instead you would be better served thinking about how you can minimise the stress to your hands during work.
For most adult men, if they’re experiencing strain from playing guitar I think it’s reasonable to conclude that there are likely to be deficiencies in technique.

I would agree with you overall here. Been trying to reduce hand stress at work, but is difficult with trades. Have simply been trying to vary activity as much as possible. Doing long, repetitive tasks (sanding down doors, for instance) is a band idea with cold hands for the record, which is why I’m neurotic about warmup now, even just physically feeling warm at least in my hands. Overall, guitar playing isn’t the main driver of overall finger and hand discomfort

I agree with the latter as well. As for the main frustration when it comes to playing – namely pinky pain during stretched chords, or during piano playing – the issue is that I can’t really see how else I would play these passages. I’m not putting undue strain on my pinky, and the nature of a stretch means that it’s largely unavoidable. So in the absence of making something easier to play, the main approach I’m left with is figuring out how to increase my tolerance in those positions. I’m sure this is something piano players have to go through, because I’ve heard of a few who have talked about injuries from trying to play Rachmaninoff passages too quickly.

You can try to reduce intensity by playing a guitar with light strings and low action. That might help. If it doesn’t, I think it’s fair to conclude that either your playing technique is problematic, or that the guitar isn’t actually the root of the problem.

I’m leaning towards the latter in this case, because I can’t really figure out what else to do, other than treat stretch-chord holds like an exercise and increase exposure over time. Already have a reasonably low action, playing 10s on a 25" PRS (which aren’t particularly tight) and have been for about 8 years. Have never had problems with my picking hand (knock on wood), despite trying to learn difficult trem picking passages.

#6

I am incredibly grateful that I was able to overcome the issues I’ve had in the past, and that I’ve been able to continue to develop techically. I sincerely hope you are able to find a solution which works for you.

Absolulutely. We’re not adapted to hold any position for extended periods of time. There is no “perfect” or “ideal” posture, but there are positions we can adopt which are naturally less strenuous to maintain, and can be maintained longer than others.

Here I have to disagree.

I’ve spent a lot of time studying the anatomical/physiological aspects of guitar technique. Understanding how our hands, wrists and forearms actually function allows us to clearly identify which muscles are aligned to a particular task, and allows us to recognise cocontractions. Understanding mechanics allows us to recognise leverage and structure.

Form or technique isn’t something you “perfect,” it’s somethign you continually refine over time. There’s also no ideal, universal technique. Technique is highly context dependent.

I would agree that it’s largely unhelpful for beginners to worry about subtle modifications or adjustments to technique and their implications. Just get some reasonable approximation of form, start playing and worry about making improvements as you need them. However, optimization is enormously beneficial, and I think it’s fair to say that most “advanced” players don’t really appreciate how deep the rabbit hole goes.

I also think that focusing on making movements “small” is a terrible idea based in very naive understanding, but that’s another rant entirely.

Also, not to boast, but I am a highly technically proficient guitarist, for whatever it’s worth. I have multiple students here on the forum who can attest to it.

If you’re warming up with any kind of “finger independence” exercises, I’d strongly recommend that you stop doing them immediately. These exercises essentially train you to contort your hands into unnatural positions through cocontractions. The coordinations involved are highly specific non-transferrable to actual playing, and the fretting postures trained are sub-optimal for actual playing. At best, they’re a complete waste of time. At worst, they’re adding to your total stress and contributing to your problems.

As I said, I don’t think there is an ideal, “perfect” technique. I also acknowledge that obsessing over technique can be unhelpful, and that there is a lot of fear-mongering in discussions of technique and the relationship to injury, catastrophizing, etc.

However, technique is a major determining factor in the stress we experience, and efficient technique does reduce injury risk by reducing stress. Washing your hands helps to prevent the spread of diseases, we shouldn’t deny that just because some people fixate unhealthily on handwashing and scrub until their skin comes off.

It’s important how we contextualize things. Most people will experience some form of RSI over the course of their lives. Some are a short-term nuisance, others are debilitating, chronic problems. Some people play guitar with highly inefficent technqiue and never experience injuries, others have excellent technique and still have problems.

However, there are certain forms which are highly correlated to injury, and there are alternatives which reduce stress enormously.

We should be encouraging people to optimize their playing technique because of what it allows us to achieve on the instrument, and because it allows us to play more and do more of what we love to do.

It’s also worth mentioning, SRV’s technique was highly optimized for that specific context. Rick Graham also has highly optimized technique in his specific context, but it wouldn’t be suitable at all for SRV’s context. Also, it’s worth mentioning that Rick plays for hours every single day.

Agreed.

I totally understand. I can play guitar all day and not experience any issues (provided I’m not doing something really stupid), gripping in Jiu-Jitsu and computer work are my primary stressors.

If you have some video, I’d be happy to see if I can help in any way.

Again, I’d suggest making a video. I’ve spent a lot of time studying fretting hand mechanics, there might be something I can suggest to help.

I think it might be worth dropping down to a set of 9s, it’s about an an 18% reduction in fretting forces and a larger reduction in bending forces (bending force depends on string diameter squared). If you’re up for it, 8s would be a very substantial reduction in minimal required forces, and if you’re hesitant, you could try a set of 9.5s.

As for specific exercises (in the strengthening sense), I’ve tried everything and none of them really helped me. I’ve tried grip strength trainers, extensor trainers, powerballs, resistance bands, everything. My hands got stronger, but it didn’t improve my situtation. You’ll never be strong enough to fight yourself and win.

#7

For my finger flexor tendinopathy, pulling exercises (rows, mainly). For wrist extensor tendinopathy, pushing exercises (bench press) and wrist extensions w/ a dumbbell. Also, eating an anti-inflammatory diet.

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#8

I’m curious, why does computer work aggravate you when guitar doesn’t? A lot of the same muscles and tendons are involved (finger flexion/extension and wrist flexion/extension).

#9

My original typing for was awful. I sat with terrible posture, and my hands were kept in a “claw” position. This position is notorious amongst physical therapists, it’s discussed here:

http://www.ergomatters.co.uk/blog/rsi/typing-with-clawed-hands/

My claw position was even worse, my MCP joints were held in the limits of extension while my DIPs and PIPs were actively flexed. This requires constant engagement of the wrist and finger extensors (extensor digitorum communis, in particular) in opposition to flexors digitorum profundus and superficialis.

This cocontraction is what lead to excessive tension and adaptive shortening of extensor digitorum communis, leading to my flexor tendinopathy (flexor carpi radialis and palmaris longus). Strengthening my hands didn’t work because I was still fighting against myself just to bring my fingers to the keys. By getting stronger, I was also putting more stress upon myself.

My typing form is much improved now. My positioning is much better and avoids this cocontraction. I take my hands away from the keyboard and “reset” in good position regularly.

However, over long periods of typing (hours in a day), my form can drift more in the direction of my older form. Also, I have a very pronounced length differential between my 3rd and 4th fingers, and this means to place my 3rd and 4th fingers on adjacent keys requires that my 4th finger is held in extension with my 3rd finger flexed. This can only be done through cocontraction. I also have more dependence between my 3rd and 4th fingers on my left hand (despite all of that “finger independence” training) than on my right and QWERTY requires more of the left hand than the right, meaning my left hand extensors fatigue sooner. I only know how to type using the standard QWERTY finger assignments.

On a guitar, I have never habituated a problematic fretting hand position. I can position my hand to facilitate my 3rd and 4th fingers working together more comfortably, or I can use alternatives when I can’t assume a suitable position.

Also, I’m much more “in tune” with my haptic experience while playing guitar than typing. Anything which would potentially be problematic, I’m much more liekly to discern by feel and intuitively or intellectually recognise it.

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#10

I used to type like that as well, and I also have a large difference between my 3rd and 4th fingers. Typing like that along with string hopping led to my wrist extensor tendinopathy in 2005 which I am still trying to get rid of 100%. I’d say I’m 90% healed currently.

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#11

I’ve been told it’s an extremely common cause of injury. As soon as my physiotherapist saw me typing, she knew that was the problem. She also said that my posture improved dramatically when playing a guitar.

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#12

Wow I cannot believe my eyes! I recently joined this on scholarship while completing my master’s in applied physiology and kinesiology so of course this topic of pain and injury caught my attention. As a coach at Barbell Medicine, you have no idea how happy it makes me to see you link this article!

My name is Ben btw (IG @ben_barbellmedicine) and I’m happy to talk fitness/guitar if you follow me there!

Hope you start to feel better soon! Maybe I’ll talk to Jordan about a hand strength program for guitarists haha.

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#13

I’ve been having some success with Timani. It’s like Alexander Technique but specifically tailored to musicians.

When I did strength training I made my situation worse. If a child is able to play the guitar, then I thinkI should be able to play it without having to do weights or use resistance bands.

I’m still not all the way better, but I’m learning to sense when I’m tensing up unnecessary muscles and putting undue stress on my tendons. Injury tends to come from sessions where I’m careless about this.

It’s helpful to devote entire weeks or months of practice to only paying attention to how it feels to play. Not what it sounds like or whether you are making mistakes.

Successful playing is comfortable. So comfortable and easy it’s surprising and fun. You feel like you could play all day. You are not worried about stamina because it feels like it’s taking nothing out of you at all.

If you can get there first, then you’re in the right place to think about how it sounds and what you’re playing.

Best of luck!

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#14

I’ve read up on and practiced the Alexander Technique and the Feldenkrais Method, but I’m not familiar with Timani. I’ll have to look into it.

Same for me when I was dealing with typing-related RSI.

I totally agree with this. An healthy adult is more than strong enough to play a guitar.

Again, I totally agree. Wishing you well on your continued journey to full recovery.

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#16

I’ve suffered on and off from tendon issues for many years and I think 5 years ago it got really bad, the worst it’s ever been. I had issues in my fingers, my wrists and even trigger finger. I saw consultants and hand specialist physios who weren’t much help at all.

Mine developed from too much use of the computer and I was also practising the clean part of Tumeni notes on the acoustic guitar as that’s what Steve Morse did! I also went from 9 to 10s on my electric.

I tried so many different things and it gradually got better, I do weights now and I think that definitely helps but it’s so easy to overdo things and make them worse.

One thing that I would say definitely works is GTN patches, which is what I used on my tennis elbow/golfers elbow and I’m now pretty much cured.

These patches are for people with heart issues but they’re pretty safe to use and after about 2 weeks of wearing them the pain was pretty much gone. The only problem is they give you pretty bad headaches if you wear them for too long, I could only ever tolerate them for 4 hours.

You literally put the patch on the point of the tendon that hurts and leave it there whilst also not doing anything that aggravates the pain.

Something that never worked for me at all was stretching, which is pretty much what everyone recommends.

#17

For the record, I’m the original poster (Longbowman); I didn’t realize I had signed up previously with a different email some years ago, and for some reason it posted through Longbowman even though that account doesn’t have a MiM subscription. Same guy though.

Thanks for the encouragement all!

Absolulutely. We’re not adapted to hold any position for extended periods of time. There is no “perfect” or “ideal” posture, but there are positions we can adopt which are naturally less strenuous to maintain, and can be maintained longer than others.

Yes, agreed. The area this gets strange is posture, particularly while sitting. There are people who sit in Notre-Dame-esque hunched positions for hours a day who don’t seem to experience pain (teenagers especially), but then they tend not to be well adapted for other activities. Motion is lotion, as they say. Age does seem to play a role here as well, what I wouldn’t give for the adaptability of a child.

We do seem to have examples of posture relevant to this though, notably Glenn Gould’s horrific piano posture that was unsustainable later in life.

Here I have to disagree.
I’ve spent a lot of time studying the anatomical/physiological aspects of guitar technique. Understanding how our hands, wrists and forearms actually function allows us to clearly identify which muscles are aligned to a particular task, and allows us to recognise cocontractions. Understanding mechanics allows us to recognise leverage and structure.
Form or technique isn’t something you “perfect,” it’s somethign you continually refine over time. There’s also no ideal, universal technique. Technique is highly context dependent.

I would agree that it’s largely unhelpful for beginners to worry about subtle modifications or adjustments to technique and their implications. Just get some reasonable approximation of form, start playing and worry about making improvements as you need them. However, optimization is enormously beneficial, and I think it’s fair to say that most “advanced” players don’t really appreciate how deep the rabbit hole goes.
I also think that focusing on making movements “small” is a terrible idea based in very naive understanding, but that’s another rant entirely.
Also, not to boast, but I am a highly technically proficient guitarist, for whatever it’s worth. I have multiple students here on the forum who can attest to it.

I don’t think I disagree with you here, and my comments on perfecting technique was mostly related to beginners. For advanced players, I would agree about technique, insofar as they’re interested in continually improving. For the guitar legends that have played from young ages many hours a day for decades, oftentimes they’ve naturally found the most efficient way to play whatever it is they’re playing. Just from observation, advanced players hurting themselves on an instrument almost always seems to come from a large change in non-adapted playing time (volume) or attempting things they’re not comfortable with for an extended period of time (load). Violinists over-preparing for a competitive environment in university, advanced players taking too much time off and jumping back in fully, a musician attempting a difficult piece they’re not comfortable with for too long a time and underpreparing, or having a sudden increase in other activities that demand use of their hands that they’re not used to. I think Rick’s hand issues fell into one of these categories; as was mentioned, kids have the dexterity to play instruments, albeit they’re far less predisposed to overuse and inflammatory issues, so while I do agree that technique plays a role in the degree of tension one experiences, I’m not sure precisely to what degree vs the aforementioned.

Again, I don’t want to dispute that technique doesn’t play a role; every legendary piano or violin teacher will emphasize as efficient technique as possible, relative to a player’s playing age. I’m just a bit on the fence to what degree technique specifically contributes, at least in some contexts – the violinist that’s under a great deal of stress and is playing 5h a day instead of 2h a day likely doesn’t have a technique problem. But then they’re likely beyond the point where technique wouldn’t be the primary contributor to issues anyway, given their adaptation to their instrument. I think Nahre Sol had a video on this where she had some issues related to outside load changes, and I think this is where strength training is actually most helpful (resilience for “normal” life).

In my case, however, given that a) I am not a guitar legend, b) missed out on decades of prep before picking up the guitar, and c) guitar playing generally doesn’t cause finger issues (occasionally improves them) but some positions contribute, I’d be more inclined to wonder if it’s a technique problem or an anatomical problem I’ll just have to work around. Still interested in improving technique regardless, and greatly appreciate your willingness to help. I’ll make a video and post, would be helpful for tips in any case. Oddly, my symptoms seem to come and go – some nerve flossing tends to help some aspects, and my pinky pain seems to extend up into my elbow and shoulder. I occasionally get the same nerve irritation when lying on my left side. Not exacerbated by weightlifts, oddly, and fingers don’t seem to get worse with weightlifting either. If anything consistency in the gym helps.

If you’re warming up with any kind of “finger independence” exercises, I’d strongly recommend that you stop doing them immediately. These exercises essentially train you to contort your hands into unnatural positions through cocontractions. The coordinations involved are highly specific non-transferrable to actual playing, and the fretting postures trained are sub-optimal for actual playing. At best, they’re a complete waste of time. At worst, they’re adding to your total stress and contributing to your problems.

That’s interesting…when I do 4 note per string exercises I’m not really trying for “finger independence” as much as playing as effortlessly and relaxed as possible, with no unnecessary or strained finger usage. Are you referring to the Petrucci warmup exercises and the like?
There was one exercise I recently discovered that I was unsure about, involving holding down a fret with a particular finger and playing the others down the strings to train holding a particular note with that finger and increasing stretch potential. Haven’t used it yet though.

t’s important how we contextualize things. Most people will experience some form of RSI over the course of their lives. Some are a short-term nuisance, others are debilitating, chronic problems. Some people play guitar with highly inefficent technqiue and never experience injuries, others have excellent technique and still have problems.
However, there are certain forms which are highly correlated to injury, and there are alternatives which reduce stress enormously.
We should be encouraging people to optimize their playing technique because of what it allows us to achieve on the instrument, and because it allows us to play more and do more of what we love to do.

Agreed. While I’m very reluctant to make universals on the topic of human anatomy anymore, at least personally, typing in that “clawed” position you mentioned has given me significant issues as well, thankfully not specifically related to guitar (at least as far as I’m aware).

I think it might be worth dropping down to a set of 9s, it’s about an an 18% reduction in fretting forces and a larger reduction in bending forces (bending force depends on string diameter squared). If you’re up for it, 8s would be a very substantial reduction in minimal required forces, and if you’re hesitant, you could try a set of 9.5s.
As for specific exercises (in the strengthening sense), I’ve tried everything and none of them really helped me. I’ve tried grip strength trainers, extensor trainers, powerballs, resistance bands, everything. My hands got stronger, but it didn’t improve my situtation. You’ll never be strong enough to fight yourself and win.

I’ve experimented with dropping tuning for lower tension and it doesn’t seem to make a great deal of difference, unfortunately. It’s a specific pinky stretch that tends to cause me issues. Using 3rd and 4th fingers in succession has always felt “difficult” or strained for me anatomically as well, but less so when playing piano.
What’s interesting to me and something I haven’t delved into a lot is how climbers are able to create incredible amounts of small-digit strength without hand injury, i.e. doing holds with their first joint only.

(PS – Just read your EDC post, and thanks for that. I’ve always been frustrated with the “guitar teaching” idea of “you have to use your 3rd and 4th in succession”, and I always felt I had an anatomical issue with that. There are times where this feels appropriate, but there are some licks and riffs I have an irritatingly hard time with specifically due to this and I generally try to get away with avoiding it as much as possible while not neglecting it entirely)

#18

@Adam_Cullen Good to know, will take a look.

When I did strength training I made my situation worse. If a child is able to play the guitar, then I thinkI should be able to play it without having to do weights or use resistance bands.

Strength training is best for overall health and resilience, IMO. I agree, but training in this context should be contextualized to rehab specifically, not being necessary for playing.

I’m still not all the way better, but I’m learning to sense when I’m tensing up unnecessary muscles and putting undue stress on my tendons. Injury tends to come from sessions where I’m careless about this.

I don’t mean to be pedantic, but I think it’s really important to mentally shift into what pain science has to say on this topic and conceptualize it as “pain” and not “injury”. Pain is frequently a danger signal that our brains need to become less sensitized to from previous insult, but all this to say that recovery is nonlinear and having better vs worse days is normal.

I agree with the idea of retraining how it “feels” to play, something I should probably do. I think Rick Graham mentioned doing this, which is how he got his technique so efficient.

@binglis Thanks! Glad to hear it. If you can convince him to do this I’d be extremely happy, it’s an area I see hugely lacking and there seems to be no dominant authority on this.

@crenfb91 What’s been your anti-inflammatory dietary approach? The obvious are avoiding refined carbs and “ultraprocessed” foods generally, high/frequent amounts of processed meat, etc. One that often gets brought up is red meat, but I’m extremely skeptical about healthy red meat (i.e. lean steaks, venison, etc) being inherently inflammatory. I believe there is research that contradicts this re: inflammatory markers, and there are many, many N=1’s of people going on carnivore-type elimination diets specifically to address this issue. I started doing spinnach and blueberry smoothies as well, as per a study I read some time ago.

#19

That makes sense.

Frustration and anxiety seem to be common contributors also.

I can’t quantify the degree, but I can only conclude from my own experience with my typing form and from helping experienced guitarists to improve their playing technique, the benefits are real and significant.

I’m not totally convinced about this. There are long established dogmas surrounding classical instrument technique. I could imagine that the players who practice for maraton sessions every single day are fervently chasing canonically “correct” form, and fighting themselves in their attempts to achieve it.

Much of the established dogmas of intrument technique (including the guitar) are based in naive or frankly nonsensical principles (“economy of motion”, “finger independence” or “control”).

People give far too much weight to what authorities say, without comprehending what they actually do. It’s not a case of “lies to children” or “learning the rules and then learning to break them.” When every great player breaks the rules (and they do, even the famously pedantic Segovia didn’t adhere to the methods he prescribed), the rules simply aren’t what people think or say they are.

Genuinely happy to help any way I can.

Relaxed and effortless is good. I’d still hold the position that the coordinations you’re training are non-transferrable to real guitar playing, and train you to habituate fretting postures which are sub-optimal in most real playing.

It’s been years since I watched Rock Discipline, so I’m not totally sure, but I recall a lot of spidery chromatic stuff at the beginning. I don’t recall anything particularly egregious, but if you search for “guitar finger independence exercises” on YouTube you’ll find many examples of what I’m talking about. I don’t want to call out anybody in particular.

I’m not very comfortable making absolute statements either, nor do I want to add to the fear mongering.

However, some positions, like the “claw” are only achievable through constant engagement of opposing musclem groups. Others stress structures in the body at angles which they are not naturally adapted to accommodate. These positions are rarely ever necessary, alternatives exist which don’t carry the same association with injury.

Again, happy to review some video.

I can find (3 4) combinations to be very comfortable in certain applications from specific fretting postures, but they feel horrible in other situations involving other specific fretting postures. A computer keyboard is by far where (3 4) combinations feel worst to me.

I’ve definitely known climbers (and jiu-jitsu practitioners) to have injured fingers. Something I notice about climbing finger holds, is that when the technique is demonstrates they let the other fingers curl to accommodate the FDP activation. I suspect the issue with this holds is more the stress placed on the finger pulleys than flexor strength, but I’m no authority on climbing.

Thanks! I hope the insights there were helpful. You might find this recent thread interesting:

#20

Frustration and anxiety seem to be common contributors also.

Definitely, and I think that’s the biggest point I want to express – pain is multifaceted, and can be a frustrating problem to pin down, especially when it becomes chronic. I’ve found it extremely helpful to avoid the “pain = injury” misconception and address it in a multifaceted way. Regarding technique as a contribution:

I can’t quantify the degree, but I can only conclude from my own experience with my typing form and from helping experienced guitarists to improve their playing technique, the benefits are real and significant.

I’m still willing to be swayed in either direction, but at least personally and from the overall consensus of music as a whole, it does seem to be the case that while individual variables are always present, modifying “load” is rather subtle with musical instruments and improvements in tension definitely do make a significant difference, especially with larger changes (the most obvious being “claw” typing vs “neutral” typing).

I’m not totally convinced about this. There are long established dogmas surrounding classical instrument technique. I could imagine that the players who practice for maraton sessions every single day are fervently chasing canonically “correct” form, and fighting themselves in their attempts to achieve it.

Possibly true, but my main point is that if you’re a 3h a day player and you suddenly jump to 5h a day because you’re anxious for an upcoming concerto or similar, there’s a very good chance pain that happens as a result is likely from the drastic increase in playing volume, even with efficient technique.

Much of the established dogmas of intrument technique (including the guitar) are based in naive or frankly nonsensical principles (“economy of motion”, “finger independence” or “control”).
People give far too much weight to what authorities say, without comprehending what they actually do. It’s not a case of “lies to children” or “learning the rules and then learning to break them.” When every great player breaks the rules (and they do, even the famously pedantic Segovia didn’t adhere to the methods he prescribed), the rules simply aren’t what people think or say they are.

I’m curious to know how this applies to an instrument like piano or violin, but in general I agree, especially for electric guitar. The success of CTC is precisely testament to this. The more I watch the inds of things experienced players simply avoid, the more I learn about genuine efficiency, as well as individual anatomical differences.

Relaxed and effortless is good. I’d still hold the position that the coordinations you’re training are non-transferrable to real guitar playing, and train you to habituate fretting postures which are sub-optimal in most real playing.

This is a good point really. It would probably be far more beneficial to warm up and aim for the same ends using scale patterns I actually use while playing.

I appreciate you not wanting to call anyone out specifically; was mostly referring to commonly used patterns for warmup which haven’t really been dissected for their usefulness. I agree with finger independence stuff now that you mention it – where is it ever really utilized in playing?

However, some positions, like the “claw” are only achievable through constant engagement of opposing musclem groups. Others stress structures in the body at angles which they are not naturally adapted to accommodate. These positions are rarely ever necessary, alternatives exist which don’t carry the same association with injury.

Just for clarity – when you say “claw”, you specifically mean wrist extension, like in the keyboard typing example you gave previously? Essentially any position where your wrist is in maximal or near-maximal extension (or flexion, really)?

I can find (3 4) combinations to be very comfortable in certain applications from specific fretting postures, but they feel horrible in other situations involving other specific fretting postures. A computer keyboard is by far where (3 4) combinations feel worst to me.

That’s fair. I’ve found hand angle to significant alleviate this. For instance, when typing, my hands are frequently not “vertical”, and are often canted. Similarly for guitar, especially higher up on the fretboard or when barring is necessary, but it depends on the lick and hand position.

I’ve definitely known climbers (and jiu-jitsu practitioners) to have injured fingers. Something I notice about climbing finger holds, is that when the technique is demonstrates they let the other fingers curl to accommodate the FDP activation. I suspect the issue with this holds is more the stress placed on the finger pulleys than flexor strength, but I’m no authority on climbing.

Didn’t mean to imply they don’t get injured, just that their adaptations absent injury are quite interesting.

Will post some more specific video of typically painful or problematic positions. In the meantime, for general playing posture and fingering:

https://www.instagram.com/p/CTtNc6dDZ27/
https://www.instagram.com/p/B4i_4J1jGL1/
https://www.instagram.com/p/CMY7ZArjlvi/

These are fairly old videos but I’m not sure my technique has changed much. Had on and off issues back then with the guitar/piano combo.

#21

I’ll write a longer response to your post later, but briefly.

When you’re in relatively parallel posture, it appears that you have constant engagement of the hypothenar muscles which are attached the the pinky. When no in use, there seems to be a fixity to your 4th finger preventing it from following the natural actions of your ring finger. I’d need more to go on to be sure (preferably YouTube video that I can slow down), but that’s my intitial impression.